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, t <br /> LAND USE PERMIT APPLICATION — Burnett County, WI ar <br /> a `° r <br /> Applicant Complete All Sections Below This Line t <br /> Permit Types and FeesfPlease,check appropriate boxes) ° <br /> C7 p <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 � 1 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 jWl State Statute 59.692(ly)Structures $350 <br /> o IN <br /> Filling/Grading $150 1 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. CD <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o ' <br /> z <br /> 0 <br /> Property Owner's Name: C_ S l i S o <br /> 0 <br /> Property Owner's Mailing Address: 4;1.S S tj f Poi- C1 N,ze-I &rLe,\ Li <br /> 9 q2 City State Zip <br /> Property Site Address: K'1'e-U r Lam eA,6,-y Z o <br /> Contact's Telephone Number: (p O l$- -7 3 .1- <br /> 00 d <br /> Contact's Email: esoL S Q H oK <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N <br /> legible and your email provider will accept emails from the following address: @BurnettCountyW[.gov °Q <br /> 5 NN <br /> Legal Description of Property: L( CSM GbU7 V 17 ?2(o( o. N <br /> Section#: P, Town#: y( N Range#: 1 6 W Town of: <br /> *Attach additional page if needed for lengthv description OR attach a copy of the deed OR attach tax system propertv page. <br /> o � <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> Proposed Use of Structure/Addit'on: abt^ --3 C1� <br /> Anticipated Start Date: (o I (Home/Cabin;Commercial Business,Bedroom;Deck;etc.) ZA* NX7 00 <br /> Building Contractor: C1tg44r-e- L(-C, Sewer Installer: Tgcho,, PL,. .6,)nj= (N <br /> LP <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ° z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: x <br /> 0 <br /> C�M�e�- au Se,-I�cLr�s <br /> �MDrn5 <br /> 2 no-� � �X.f ee�1 � Pam' <br /> > Fee Rec: ` <br /> ONo� -!, W4 h.U"�.�. <br /> Yef4riohiyl z Check <br /> Date of staff site visit: lY 5 Z�Z`� b([3 25 Initials of site visit staff-4& n Q <br /> APPROVED BY LAND SERVICES OFFICIAL4:7�' DATE: 3 �UZ�J w -D< <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 0 <br /> 00 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> CD <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application—Rev 11/2024 <br />